The role of adjuvant chemotherapy for patients with resected pancreatic cancer: Systematic review of randomized controlled trials and meta-analysis

Stefan Boeck, Donna P Ankerst, Volker Heinemann

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Background: In patients undergoing surgery for resectable pancreatic cancer prognosis still remains poor. The role of adjuvant treatment strategies (including chemotherapy and chemoradiotherapy) following resection of pancreatic cancer remains controversial. Methods: A Medline-based literature search was undertaken to identify randomized controlled trials that evaluated adjuvant chemotherapy after complete macroscopic resection for cancer of the exocrine pancreas. Five trials of adjuvant chemotherapy were eligible and critically reviewed for this article. A meta-analysis (based on published data) was performed with survival (median survival time and 5-year survival rate) being the primary endpoint. Results: For the meta-analysis, 482 patients were allocated to the chemotherapy group and 469 patients to the control group. The meta-analysis estimate for prolongation of median survival time for patients in the chemotherapy group was 3 months (95% CI 0.3-5.7 months, p = 0.03). The difference in 5-year survival rate was estimated with 3.1% between the chemotherapy and the control group (95% CI -4.6 to 10.8%, p > 0.05). Conclusion: Currently available data from randomized trials indicate that adjuvant chemotherapy after resection of pancreatic cancer may substantially prolong disease-free survival and cause a moderate increase in overall survival. In the current meta-analysis, a significant survival benefit was only seen with regard to median survival, but not for the 5-year survival rate. The optimal chemotherapy regimen in the adjuvant setting as well as individualized treatment strategies (also including modern chemoradiotherapy regimens) still remain to be defined.

Original languageEnglish (US)
Pages (from-to)314-321
Number of pages8
JournalOncology
Volume72
Issue number5-6
DOIs
StatePublished - Feb 2008
Externally publishedYes

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Adjuvant Chemotherapy
Pancreatic Neoplasms
Meta-Analysis
Randomized Controlled Trials
Survival
Drug Therapy
Survival Rate
Chemoradiotherapy
Exocrine Pancreas
Control Groups
Disease-Free Survival
Therapeutics

Keywords

  • Adjuvant chemotherapy
  • Chemoradiation
  • Meta-analysis
  • Pancreatic cancer

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

The role of adjuvant chemotherapy for patients with resected pancreatic cancer : Systematic review of randomized controlled trials and meta-analysis. / Boeck, Stefan; Ankerst, Donna P; Heinemann, Volker.

In: Oncology, Vol. 72, No. 5-6, 02.2008, p. 314-321.

Research output: Contribution to journalArticle

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abstract = "Background: In patients undergoing surgery for resectable pancreatic cancer prognosis still remains poor. The role of adjuvant treatment strategies (including chemotherapy and chemoradiotherapy) following resection of pancreatic cancer remains controversial. Methods: A Medline-based literature search was undertaken to identify randomized controlled trials that evaluated adjuvant chemotherapy after complete macroscopic resection for cancer of the exocrine pancreas. Five trials of adjuvant chemotherapy were eligible and critically reviewed for this article. A meta-analysis (based on published data) was performed with survival (median survival time and 5-year survival rate) being the primary endpoint. Results: For the meta-analysis, 482 patients were allocated to the chemotherapy group and 469 patients to the control group. The meta-analysis estimate for prolongation of median survival time for patients in the chemotherapy group was 3 months (95{\%} CI 0.3-5.7 months, p = 0.03). The difference in 5-year survival rate was estimated with 3.1{\%} between the chemotherapy and the control group (95{\%} CI -4.6 to 10.8{\%}, p > 0.05). Conclusion: Currently available data from randomized trials indicate that adjuvant chemotherapy after resection of pancreatic cancer may substantially prolong disease-free survival and cause a moderate increase in overall survival. In the current meta-analysis, a significant survival benefit was only seen with regard to median survival, but not for the 5-year survival rate. The optimal chemotherapy regimen in the adjuvant setting as well as individualized treatment strategies (also including modern chemoradiotherapy regimens) still remain to be defined.",
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